Ship's tilt was steering error

298 passengers were injured in a 2006 mishap

The violent tilt of a cruise ship that injured 298 people in 2006 was caused by a bridge officer's steering mistake, according to federal safety findings issued Thursday.

But the stage was set for the miscue by the ship's two top officers, who misunderstood why the ship was not behaving properly, the National Transportation Safety Board concluded.

The Crown Princess lurched up to 24 degrees to the side after departing Port Canaveral on July 18, 2006, with more than 3,000 people aboard. The tilting, which lasted 3 minutes, overturned furniture and shattered glass throughout the ship. More than 100 passengers were hospitalized after the ship returned to port.

When the incident occurred, the ship's second officer had just taken command and became alarmed by a sharp turn to the port. He disengaged the automatic steering and then inexplicably turned the ship more sharply to port for six seconds, the opposite of his intention to turn starboard, the NTSB found.

He then entered a series of steering commands that compounded the problem. "As far as we were able to tell, this was an isolated, one-off thing," said NTSB Office of Marine Safety director Jack Spencer, at a board meeting Thursday.

But investigators said the ship's captain and staff captain had set the ship's speed at a fast 20 knots to get ahead of a storm off the coast of North Carolina. The ship still was in relatively shallow water, causing it to "squat," or lower, in the water and its heading to fluctuate. In addition, the rudder settings programmed into the steering system were maximized for heavy weather, not the calm seas the ship was experiencing.

The combination caused the Crown Princess to begin changing directions. Because the ship was only a month old, the captains attributed that to a bug in the automated steering program.

"The crew thought they had solved the problem when they had not," said Dr. Barry Strauch, a human performance specialist at the safety agency.

One board member said Princess Cruises, the operator of the Crown Princess, had five tilting episodes in 14 months, although the Crown Princess was by far the most severe.